What are haemorrhoids?
Haemorrhoids are swollen blood vessels in or around the anus and rectum.
The haemorrhoidal veins are located in the lowest part of the rectum and the
anus. Sometimes they swell so that the vein walls become stretched, thin, and
irritated by passing bowel movements. Haemorrhoids are classified into two
general categories: internal and external.
Internal haemorrhoids lie far enough inside the rectum that you can't see or feel
them. They don't usually hurt because there are few pain-sensing nerves in
the rectum. Bleeding may be the only sign that they are there. Sometimes
internal haemorrhoids prolapse, or enlarge and protrude outside the anal
sphincter. If so, you may be able to see or feel them as moist, pink pads of
skin that are pinker than the surrounding area. Prolapsed haemorrhoids may
hurt because they become irritated by rubbing from clothing and sitting. They
usually recede into the rectum on their own; if they don't, they can be gently
pushed back into place.
External haemorrhoids lie within the anus and are often uncomfortable. If an
external haemorrhoid prolapses to the outside (usually in the course of passing
a stool), you can see and feel it. Blood clots sometimes form within prolapsed
external haemorrhoids, causing an extremely painful condition called a
thrombosis. If an external haemorrhoid becomes thrombosed, it can look rather
frightening, turning purple or blue, and could possibly bleed. Despite their
appearance, thrombosed haemorrhoids are usually not serious and will resolve
themselves in about a week. If the pain is unbearable, the thrombosed
haemorrhoid can be removed with surgery, which stops the pain.
Anal bleeding and pain of any sort is alarming and should be
evaluated; it can indicate a life-threatening condition, such as colorectal
cancer. Haemorrhoids are the
main cause of anal bleeding and are rarely dangerous, but a definite diagnosis
from your doctor is essential.
What causes haemorrhoids?
Anyone at any age can be affected by haemorrhoids. They are very
common, with about 50% of people experiencing them at some time in their life.
However, they are usually more common in elderly people and during pregnancy. Researchers are not certain what causes
haemorrhoids. "Weak" veins - leading to haemorrhoids and other varicose
veins - may be inherited.
It's likely that extreme abdominal pressure causes the veins to
swell and become susceptible to irritation. The pressure can be caused by
obesity, pregnancy, standing or sitting for long periods, straining on the
toilet, coughing, sneezing,vomiting, and holding your breath while straining to do
physical labour.
Diet has a pivotal role in causing - and preventing -
haemorrhoids. People who consistently eat a high-fibre diet are less likely to
get haemorrhoids, but those who prefer a diet high in processed foods are at
greater risk of haemorrhoids. A low-fibre diet or inadequate fluid intake can
cause constipation, which can contribute to haemorrhoids in two ways: it
promotes straining on the toilet and it also aggravates the haemorrhoids by
producing hard stools that further irritate the swollen veins.
What are the symptoms of piles?
The symptoms of haemorrhoids include:
·
Bright red bleeding from the anus. Blood may streak the bowel
movement or the toilet paper.
·
Tenderness or pain during bowel movements.
·
Painful swelling or a lump near the anus.
·
Anal itching.
·
A mucous anal discharge.
Seek medical advice if:
·
You have rectal
bleeding for the first time, even
if you believe you have haemorrhoids. Colon
polyps, colitis, Crohn's disease, and colorectal
cancer can also cause rectal bleeding. An accurate diagnosis is essential.
·
You have been diagnosed with haemorrhoids,
and you have rectal bleeding that is chronic (daily or weekly) or more profuse
than just streaking. Though rare, excessive haemorrhoidal bleeding can
cause anaemia.
How do I know if I have piles?
First, your doctor will look at the anal area, perhaps by
inserting a lubricated gloved finger or an anoscope (a hollow, lighted tube for
viewing the lower few inches of the rectum) or a proctoscope (which works like
an anoscope, but provides a more thorough rectal examination).
More procedures may be needed to identify
internal haemorrhoids or rule out other ailments that frequently
cause anal bleeding, such as anal
fissure, colitis, Crohn's disease, and colorectal cancer.
To see further into the anal canal (into the lower, or sigmoid,
colon), sigmoidoscopy may be used, or the entire colon may be viewed with colonoscopy. For both procedures, a
lighted, flexible viewing tube is inserted into the rectum. A barium X-ray can
show the entire colon's interior. First a barium
enema is given and then X-rays
are taken of the lower gastrointestinal tract.
What are the treatments for piles?
There are treatments for piles available from pharmacies or
through a GP.
Creams, ointments and suppositories can help relieve swelling and inflammation
symptoms in the short term. A GP may recommend corticosteroid cream for severe
inflammation.
Warm (but not hot) sitz baths are a traditional therapy for piles: sit in about
8 cm of warm water for 15 minutes, several times a day, especially after a
bowel movement.
Painkillers, such as paracetamol, can help relieve pain
caused by piles. Products with local anaesthetic may be
prescribed to treat painful haemorrhoids.
If you are constipated, a GP may recommend using a laxative.
However, these treatments do not get rid of the haemorrhoids themselves.
If you are pregnant, discuss any treatment, including dietary changes, with
your doctor before proceeding.
If symptoms persist, your doctor may suggest one of the following procedures.
Many can be performed as a day-case:
Injection or sclerotherapy. An internal haemorrhoid can be
injected with a solution that creates a scar and closes off the haemorrhoid.
The injection will only hurt a little.
Banding. Prolapsed haemorrhoids are often removed using rubber-band
ligation. A special tool secures a tiny rubber band around the haemorrhoid,
shutting off its blood supply almost instantly. Within a week, the haemorrhoid
shrivels and falls off.
Coagulation or cauterisation. Using either an electric probe, a laser
beam, or an infrared light, a tiny burn painlessly seals the end of the
haemorrhoid, causing it to close off and shrink. This is most useful for
prolapsed haemorrhoids.
Surgery. For large internal haemorrhoids or extremely uncomfortable
external haemorrhoids (such as thrombosed haemorrhoids that are too painful to
live with), your doctor may choose traditional surgery, called
haemorrhoidectomy.
The success rate for haemorrhoid removal approaches 95%, but unless dietary and
lifestyle changes are made, haemorrhoids may recur.
NON SURGICAL / NON INVASIVE
Piles i e. Hemorrhoid and Fistula are diseases of blood vessel, either artery or vein. When distended blood vessels further distended or compressed may rupture and cause even torrential bleeding inside the anal canal. Piles is varicose vein of anus and rectum, it is also said to be aneurysm of blood vessel.
Causes
- Gravity - Erect Posture. So occurs only in humans and not in animals.
- Heredity - If one parent is having piles, the chance is higher in children and if both parents have piles, the chance for children is still higher.
- Diet - Low fiber content in diet; fast food, tinned food, soft food, bakery food, lack of fruits and vegetables.
- Smoking, alcohol, too much intake of chillies and spices and low intake of fluids.
- Habit and Occupation - Constipation, diarrhea, sedentary life, lack of exercise, long sitting and standing, continuous cycle riding.
- Frequent enema, excessive use of cold water
Symptoms
- Mass per rectum bleeding per rectum Constipation
- Feeling of incomplete emptying even after defecation
- Feeling of frequent emptying
- Frequency of irritation, pain motion, burning, itching.
- Retention of urine.
- Incontinence of urine and motion
- Blood in motion:
(a) mixed with motion
b) marking
c) spraying
d) fresh flow
e) clots
Treatment
- Bengali Ligation - Crude and unscientific. Not observing sterile Technique. Even educated people are misled.
- Rubber band ligation -Not effective. Temporary benefit for early piles only.
- Injections of sclerosis agents - obsolete and not effective
- Haemorrhoidectomy (Surgical removal of d) Needs longer hospitalization, Expensive, requires more man power and money. Does not guarantee 100% cure.
- Cryosurgery - (Karikal) - Using ice and C02, Not effective, recurrence definite.
- Stapling - Expensive and not very popular; Not without complication.
- I.R.C - (German Technique) -infra Red Coagulation, less expensive, less pain, Effective for early piles, internal piles and for controlling bleeding.
- KM 25 (DGHAL) (American Technique) -Vessel ligation Technique. Detecting the pulsation of the vessels using Doppler Guided Ultra sound and ligating the vessel. Very effective for internal hemorrhoid. Treatment time less than half an hour. Less pain, less bleeding and day care procedure. Can go home on the same day. Can do the routine from the next day.
- C.T. Laser - Modern and effective method. Less pain, less bleeding, day care procedure, No recurrence, almost 100% effective for piles, fissure and fistula (both low & high)
- HFLT - Modified form of laser: Less penetrating and hence less chance for charring and carbonization. Effective in presence of water and blood.
H FISSURE
Cracks or cuts around the anus. Fissures appear in succession. Earlier ones heal and later ones appear causing scarring and stricture. Needs Anal dilation.
Symptoms - Pain, Constipation and bleeding.
Food - Patients better to avoid chillies and low fiber content diet.
FISTULA (LOW AND HIGH)
Holes or opening in and around the anal canal. May remain healed at times and symptomatic at other times. Causing discharging, pus, fluid, blood, motion or both.
(i) Low fistula: Treatment: Using laser either cutting open or blind.
(ii) High fistula: Blind laser treatment May require 2nd sitting.
RECTAL PROLAPSE
Due to laxity of pelvic muscles.
(a) Partial (mucosal) Treatment: mucosal ligation and laser excision.
(b) Complete: AH layers prolapsed
Treatment:
Tightening of anal sphincter and fixing the rectum of the pelvic muscles.
Causes of Rectal Prolapse:
1.Congenital
2.Acquired Due to diarrhea, malnutrition
Al-Shifa Super Speciality Hospital for Piles based in Ernakulam, Kerala, is a hospital specialising in the treatmentt of Piles, Fistula and other related diseases. Incepted as a division of Al-Shifa Educational and Charitable Trust - a charitable institution running on a non-profit non-loss basis, the hospital has already earned the reputation of being the best-equipped hospital for piles treatment in India. The Hospital for Piles also provides high quality, compassionate and personalized health care coupled with efficient and empathetic nursing care...
Nutrition and diet
You can prevent constipation by following a high-fibre
diet. Meals and snacks should consist primarily of vegetables, fruit, nuts, and
whole grains, and as few processed foods and meats as possible. If this is a
big change for you, introduce the new foods slowly, to avoid wind.
If you aren't able to eat enough high-fibre food, supplement your
diet with stool softeners or bulk-forming agents. (Avoid laxatives, which may
cause diarrhoea that can further irritate the swollen veins.)
Drink at least eight glasses of water each day; if your life is
especially active or you live in a hot climate, you will need more.
Monitor your salt intake. Excess salt in the diet causes fluid
retention, which means swelling in all veins, including haemorrhoids.
At-home remedies
·
Try not to sit for hours
at a time. If you have to, take breaks: once every hour, get up and move around
for at least five minutes. A doughnut-shaped cushion can make sitting more
comfortable and ease haemorrhoid pressure and pain.
·
Insert petroleum jelly just inside the anus to
make bowel movements less painful.
·
Consider
dabbing witch hazel (a soothing
anti-inflammatory agent) on irritated haemorrhoids to reduce pain and itching.
·
Resist the temptation to
scratch haemorrhoids, as it makes everything worse: the inflamed veins become
more irritated; the skin around them becomes damaged; and the itching itself
intensifies. Instead, to help reduce swelling and irritation consider using an
over-the-counter steroid cream to the skin (not inside the anus - on the
outside only) and a cold pack. You might try over-the-counter haemorrhoidal
creams for relief from itching.
·
If you need a pain
reliever, consider using paracetamol.
·
Bathe regularly to keep
the anal area clean, but be gentle: excessive scrubbing, especially with soap,
can intensify burning and irritation.
·
Don't sit on the toilet
for more than five minutes at a time, and when wiping, be gentle. If toilet
paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes. You may prefer washing yourself and then
dabbing the area dry.
·
When performing any task
that requires exertion, be sure to breathe evenly. It's common to hold
your breath during exertion, and if you do, you're straining and contributing to haemorrhoid swelling.
How can I prevent
piles?
A healthy diet and lifestyle are good insurance for preventing
haemorrhoids, whether you already suffer haemorrhoid symptoms or are intent on
preventing them. Regular exercise is also important, especially if you have a
sedentary job. Exercise helps in several ways: keeping weight in check, making
constipation less likely, and enhancing muscle tone.
Healthy bowel habits also help prevent haemorrhoids. Use the
toilet as soon as you feel the urge to do so. Also, avoid sitting on the toilet
for prolonged periods (more than five minutes) and avoid straining during a
bowel movement.
